Thursday, October 30, 2014

So you wanna be an anaesthetist?: 1.Pre Op assessment Part 1

The most important thing to do as an anaesthetist when a case is posted; is to see the patient. It is essential for anaesthetist to know the patient as a whole before subjecting him the the most appropriate aanesthetic technique for the procedure. Being perioperative physicians therefore the usual history,examination and investigation review are as essential like any other discipline. Based on this, we are to plan our technique so that the surgery can be done in the most successful manner. 
I used to hate doing premed rounds when i first started in HKL. A single person is expected to see other people's list and it can be a lot! What was supposed to be an easy breeze afternoon ends up making me go back after 9pm. The worst was Sunday premeds.. it can take the whole day to settle all the patients! Being thorough meant i had to spend at least half an hour to settle one ASA 3 patient!  What makes it troublesome was when the patient was not worked up ie investigations not completed, no cardiac assessment etc. Having to call different specialists to inform and decide on the management can be daunting as everybody had a different view of how it is supposed to be done. Some may be really contra!! This has been the practice and i am sure it still is in our government hospitals. 
When i was in UM, it was made a point that the team or person doing the list should see their own patients. Initially I felt it was a bit taxing and strange but later i do realize it is important to know your own patient. Who else can tell you about difficult airway unless you assess them yourself ( i can be very OCD on this especially if knowing the patient is obese) or patient's general condition which sometimes can be overrated during phone conversations. 
In CTC, i had my own pre-op CABG clinic. When it is possible, i will schedule my CABG patients to see me so that i know them and the explanation about the whole care process can be given. In Malaysia this will not be a common practice but why be common? CTC was different in the sense of it was more of individual care unlike the mass care basis of IJN, I felt it was essential to describe the whole process especially in ICU as it may alleviate some anxiety later among the family members. 
Now in private practice, i do hope to be able to see the patients as much as possible before OT. We are the consultants therefore it would be entirely on us or our partners. Since we are charging them, i feel it is inappropriate to just see them in OT for the pre op assessment. Despite most patients maybe ASA 1 & 2, it would make a whole lot of difference when we see them in the ward. I am in the process of preparing leaflets and info sheets for my patients so that they have an idea about anaesthesia before meeting me.
The reason why i feel it is important for patients to know more about anaesthesia is becasue of our risks. I will explain this in a more detailed manner in my future postings. Honestly, before Op we hardly spend that much of a time with the patient in taking their consent. Imagine a 5-10 minutes meet. How much can we really make them understand about anaesthesia and its risks? Its not uncommon for anaesthetist to be sued after with the lawyers claiming that we did not explain enough eventhough it was legally consented. It can still be argued which i can see why. There are anaesthetists who would try to make the meeting as short as possible.
I reckon the sample info provided by the Great Britain Anaesthetist is excellent! It is comprehensive and the information is enough to make any lay person understands. I wonder why my local anaesthesia fraternity did not undergo such project which i reckon would be useful for everyone. Perhaps i should initiate this project rather than complaining why others did not.. haha well, in fact, i'm doing something about it with my hospital. 

No comments: